Mycobacterium haemophilum infection with prominent facial manifestation mimicking leprosy.

Mycobacterium haemophilum is a slow-growing non-tuberculous mycobacterium that is rarely known to cause human skin infection, particularly in immunocompromised patients. We recently experienced a 69-year-old Japanese woman with this infection who had been under immunosuppressive treatment for recalcitrant rheumatoid arthritis. The patient showed disseminated erythematous plaques and subcutaneous nodules on the face and extremities, and interestingly, the face manifested with a striking "facies leontina" appearance. Biopsy revealed abscess and granulomatous dermatitis with the involvement of peripheral nerve bundles and the presence of innumerable acid-fast bacilli, thus necessitating differentiation from lepromatous leprosy. M. haemophilum was identified by molecular characterization as well as by successful culture with iron supplements. Although drug susceptibility testing indicated responsiveness to multiple antibiotics administrated simultaneously for the treatment, it took over 6 months to achieve significant improvement, and we also employed concurrent oral potassium iodide administration and repeated surgical excision. This case highlights the importance of continuous combination therapy for successful outcome in this rare infection. Furthermore, application of potassium iodide for mycobacterial infection warrants further evaluation by accumulating more cases.

Iodine excess as an environmental risk factor for autoimmune thyroid disease.

The global effort to prevent iodine deficiency disorders through iodine supplementation, such as universal salt iodization, has achieved impressive progress during the last few decades. However, iodine excess, due to extensive environmental iodine exposure in addition to poor monitoring, is currently a more frequent occurrence than iodine deficiency. Iodine excess is a precipitating environmental factor in the development of autoimmune thyroid disease. Excessive amounts of iodide have been linked to the development of autoimmune thyroiditis in humans and animals, while intrathyroidal depletion of iodine prevents disease in animal strains susceptible to severe thyroiditis. Although the mechanisms by which iodide induces thyroiditis are still unclear, several mechanisms have been proposed: (1) excess iodine induces the production of cytokines and chemokines that can recruit immunocompetent cells to the thyroid; (2) processing excess iodine in thyroid epithelial cells may result in elevated levels of oxidative stress, leading to harmful lipid oxidation and thyroid tissue injuries; and (3) iodine incorporation in the protein chain of thyroglobulin may augment the antigenicity of this molecule. This review will summarize the current knowledge regarding excess iodide as an environmental toxicant and relate it to the development of autoimmune thyroid disease.

[Global leprosy situation, beginning of 2008].

The epidemiological situation of leprosy is reported by the health division of each country to WHO. The reported data is collected by WHO and is immediately run on the Weekly Epidemiological Record. On this latest edition, data from the beginning of 2008 was reported. In almost all of the highly endemic countries, control activities have been integrated within the general healthcare system. However, maintaining political interest and mobilizing the necessary funds to implement activities in the field are challenges for many national programmes as the burden of disease declines further.

[Present leprosy situation in the world in 2006].

The epidemiological situation of leprosy is reported by the health division of each country to WHO. The reported data is collected by WHO and is immediately run on the Weekly Epidemiological Record. On this latest edition, data from the beginning of 2006 was reported. Early case detection and treatment with multidrug therapy (MDT) remains the cornerstone of leprosy control. The challenge will be to establish these facilities as part of an integrated system that provides referral services for other diseases in the area.

[Leprosy situation in Myanmar before and after multidrug therapy].

We introduced history of leprosy in Myanmar based on the book of Myanmar Academy of Medical Science published entitled "CONQUEST OF SCOURGES IN MYANMAR (Complied and Edited by Ko Ko, Kyaw and U Thaung) at 2002. "Leprosy Elimination Programme in Myanmar (Kyaw Lwin and Kyaw Nyunt Stein)" was appeared at chapter III in it. After dapsone treatment appeared, leprosy control program has started. Health system and service were developed and leprosy control program was also included in them. The integration of the elimination activities into basic health workers, such as midwives and health volunteers, has enabled the participation of a wide range of people in the community. After 1990s, multidrug therapy (MDT) was covered whole area of Myanmar, and task force for leprosy elimination was formed at Sate/Division, District and Township level. Finally Myanmar achieved the elimination of leprosy in January in 2003.

[Bacteriological features of Mycobacterium haemophilum isolated from skin lesions in an immunodeficient patient].

A 53-year-old, male patient presented with pain in the middle area of the back of his left foot. The painful area was associated with a reddish dome-shaped swelling of 24 by 18 mm which had ulcerated in the center part. Histopathologically, the cutaneous lesion consisted of an ulcer surrounded by abscess and granuloma and numerous acid-fast organisms were observed. Subsequently, the area just below the left inguinal area developed redness and swelling approaching the size of a quail egg. The patient responded favorably with rifampicin, levofloxacin, and minocycline therapy. The patient was immunodeficient, but negative for HIV-1 and HIV-2 antibodies and the etiology of his immunodeficient state is unclear. Skin tissues or pus were cultured at 37 degrees C on 2% Ogawa and BBL MGIT. Acid-fast organisms were recovered on MGIT within 4 to 12 days, while 2% Ogawa medium failed to recover acid-fast bacteria. Using growth from the positive MGIT tube as inoculum, MycoBroth, 7H9 broth, 7H11.2% Ogawa supplemented with or without iron complexes, and blood agar were inoculated and cultured at 30 and 37 degrees C. Growth at 30 and 37 degrees C was seen with MycoBroth, 7H9, hemin (60 microM) or ferric ammonium citrate (15 mg/ml) supplemented 7H11 and blood agar as well as 7H11 supplemented with factor X. Growth at 30 degrees C only was observed for ferric ammonium citrate supplemented 7H9 and 2% Ogawa. Generally, growth at 30 degrees C was better than that at 37 degrees C in all media. No growth at either temperature was observed with hemin or factor X supplemented 2% Ogawa. With respect to the biochemical characterization, the isolate was negative for niacin, nitrate reduction, urease, arylsulfatase, Tween 80 hydrolysis, catalase, 68 degrees C catalase, acid phosphatase, and tellurite reduction, while strongly positive for neutral red test. Sequencing of the 16S rRNA gene showed the isolate to be consistent with Mycobacterium haemophilum. Based on the composite characterization, the isolate was identified as M. haemophilum. This is the second case report of M. haemophilum infection in Japan in the literature.